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Salicylate toxicity is a medical emergency. Intentional ingestion or accidental overdose can cause severe metabolic derangements making treatment difficult. Co-ingestion of other medications can further complicate management. , (Copyright © 2022, StatPearls Publishing LLC.)

Many diseases and conditions list pain as a component of their presentation; as a result, pain management is of great importance to clinicians and patients alike. Acetaminophen (APAP - also known as paracetamol in many countries) is a non-opioid analgesic and antipyretic agent used to treat pain and fever. It is used as a single agent for mild to moderate pain and combined with an opioid analgesic for severe pain. This activity outlines the use, dosing, indications, contraindications, toxicity, and toxicity management of acetaminophen and highlights the role of the interprofessional team in caring for patients who take acetaminophen., (Copyright © 2022, StatPearls Publishing LLC.)

Warfarin is a vitamin K antagonist used as an anticoagulant used for treatment and prevention of a variety of coagulopathic and thromboembolic disorders. While it was initially marketed as a rodenticide, it has been used as a medication for more than a half-century. Additionally, superwarfarins are now also used as pesticides and should be considered as agents that may cause potential “warfarin toxicity” and have been noted to be one hundred times as potent compared to warfarin. Toxicity can be thought to occur in a variety of methods: 1) Intentional adult overdose; 2) Unintentional overdose/toxicity, and 3) pediatric ingestion. The intentional overdose may be the most obvious, though has been noted to be “relatively rare,” with one 25-year survey of two tertiary centers with toxicology services having a total of 22 non-pediatric intentional overdoses. Unintentional overdose or toxicity can occur through various mechanisms such as during the initial dosing phase, change in diet, interaction with other medications, and even secondary to metastatic liver disease. The initial dosing phase presents a specific timeframe of potential toxicity and risk not only due to potentially known aspects such as the patient’s specific comorbidities and diet, but also due to their genetic polymorphisms. Pediatric ingestion may result in warfarin toxicity and can occur due to exploratory ingestion of a child unknowingly taking a pill, as well as through potential Munchausen syndrome by proxy. In addition to the previously discussed methods of intoxication, there have also been reports of warfarin toxicity due to lacing superwarfarins with illicit drugs to prolong euphoric effects., (Copyright © 2022, StatPearls Publishing LLC.)

Isopropanol, or isopropyl alcohol, is a clear, colorless liquid that emits an odor that resembles acetone. It is a commercially available product that mainly is found as a 70% solution in rubbing alcohol and hand sanitizers. Unlike the other toxic alcohols, isopropanol rarely causes death and is associated with ketosis without acidosis. Treatment of isopropanol ingestions is typically supportive therapy and ingestions are rarely lethal., (Copyright © 2022, StatPearls Publishing LLC.)

The black widow spider species, also known by its biological nomenclature as the  Latrodectus  species is one of more than 40,000 different species of spiders. Clinically, it is one of most significant species of spiders worldwide. Within the United States, it is responsible for most of the clinically significant envenomation among all species of spiders. There are more than 30 different types of black widow spiders worldwide; however, not all species are as relevant due to their separation from human habitat. The genus Latrodectus derives its ubiquitous nickname “black widow” from its physical characteristics. The Black Widow, or Latrodectus mactans, is easily identified by its characteristic shiny black body and strikingly red hourglass-shaped marking on the abdomen. Interestingly, this species is well known by the phenomenon of the female spider devouring the male spider after mating, thereby making her a widow. Black widow spiders range from 5 to 15 mm (0.25 to 0.50 inch) in length. They have fangs and venomous glands sufficient to cause harm to humans. The female gender of the species is the most dangerous, compared to their male counterparts.  Females have more prominent venomous glands, longer fangs and a body size that can reach up to 20-times larger than their male counterparts. Symptoms of envenomation range from local irritation and pain to a more systemic syndrome termed “latrodectism.” Latrodectism is characterized by variations in presentations ranging from autonomic disturbances to widespread pain and rigidity. Treatment ranges from simple analgesia to the administration of antivenom., (Copyright © 2022, StatPearls Publishing LLC.)

Methanol (CH3OH) is a toxic alcohol that is found in various household and industrial agents. The term “toxic alcohols” is a collective term that includes methanol, ethylene glycol, and isopropyl alcohol. Methanol exposure can be extremely dangerous, with significant morbidity and mortality if left untreated. Methanol poisoning is most often due to accidental or intentional ingestions, and accidental epidemic poisonings due to distilling and fermenting errors and beverage contamination. Products that contain methanol include windshield washer fluid, gas line antifreeze, carburetor cleaner, copy machine fluid, perfumes, food warming fuel, and other types of fuels. Exposures can cause varying degrees of toxicity and can require a range of treatments from close laboratory monitoring to antidotal therapy and dialysis. The primary treatments are either ethanol or fomepizole, and unlike ethylene glycol toxicity, dialysis is often recommended., (Copyright © 2022, StatPearls Publishing LLC.)

Glipizide is a second-generation sulfonylurea that is FDA-approved for the treatment of adults with diabetes mellitus type 2. It is administered as an adjunct to diet and exercise. It can be combined with metformin to reach goal HbA1c in patients with not adequate metabolic control in 3 months, despite compliance with diet, exercise, and medication. This activity will highlight the indications, mechanism of action, contraindications, adverse event profile, and potential toxicity of glipizide pertinent for members of the interprofessional team in the management care of patients with diabetes using glipizide., (Copyright © 2022, StatPearls Publishing LLC.)

Clonidine is a commonly prescribed biochemical derivative of imidazoline with a variety of clinical uses. It was originally developed as a nasal decongestant, but its main use has been as an anti-hypertensive agent. In recent years it has gained popularity in pediatric patients for the treatment of attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, and sleep disturbances. It has also been shown to be useful in treating several different drug withdrawal syndromes. Clonidine’s effect on the body stems from its action on alpha-2 receptors, imidazoline receptors, and the functional overlap of alpha-2 receptors on mu receptors. Overdose results in a toxidrome not easily identified. Even at therapeutic doses, clonidine has a number of anticholinergic side effects that include dry mouth, constipation, and sedation. However, at toxic doses, it can cause hemodynamic instability and depression., (Copyright © 2022, StatPearls Publishing LLC.)

Alpha-adrenergic agonist toxicity is due to a broad group of pharmaceutical agents known as alpha agonists, which can be further broken down into central alpha-2 agonists and peripheral alpha-1 agonists. Central alpha-2 agonists include clonidine, guanfacine, tizanidine, guanabenz, and methyldopa. Peripheral alpha-1 agonists include imidazoline, oxymetazoline, tetrahydrozoline, and naphazoline. Mainly there are 2 alpha receptors of pharmacological significance – central alpha-2 and peripheral alpha-1 adrenergic receptors. Stimulation of central alpha-2 receptors causes decreased secretion of catecholamines through a negative feedback mechanism. Stimulation of peripheral alpha-1 receptors primarily increases blood pressure via induced vasoconstriction. Alpha-adrenergic agonist toxicity is of primary concern with alpha-2 adrenergic agonist xenobiotics through the resulting depletion of catecholamines associated with these agents; however, there are many topical alpha-1 agonists that when misused cause similar toxicity. Toxicity is encountered in various populations, particularly in children and adolescents, due to the growing use of these agents. Toxicity is associated with a compilation of symptoms, including central nervous system depression, bradycardia, and hypotension. Alpha-adrenergic toxicity is often very responsive to supportive care, including intravenous fluid administration, airway monitoring, and repletion of catecholamines as necessary via the use of vasopressor agents. There is no antidote approved for human use, and naloxone has no proven efficacy., (Copyright © 2022, StatPearls Publishing LLC.)

Methemoglobinemia is a condition with life-threatening potential in which diminution of the oxygen-carrying capacity of circulating hemoglobin occurs due to conversion of some or all of the four iron species from the reduced ferrous [Fe2+] state to the oxidized ferric [Fe3+] state. Ferric iron is unable to bind and transport oxygen. Increased levels of methemoglobin results in functional anemia., (Copyright © 2022, StatPearls Publishing LLC.)

Cannabinoids are a collective group of compounds that act on cannabinoid receptors. They include plant-derived phytocannabinoids, synthetic cannabinoids, and endogenously-derived endocannabinoids. The primary source of cannabinoid toxicity is from plant-derived cannabinoids and synthetic cannabinoids. These agents act as cannabinoid receptor agonists. More than 60 naturally occurring cannabinoids are found in the Sativa and Indica species of Cannabis, with delta-9 tetrahydrocannabinol (THC) being the main psychoactive compound. Other naturally occurring cannabinoids include cannabidiol and cannabinol. Marijuana is the most common colloquial name for crushed, dried leaves and flowers of the Cannabis plant. In recent years, there have been many reports of marijuana toxicity, primarily in the pediatric population, as medical and recreational marijuana has been legalized. The terms phytocannabinoids, marijuana and cannabis are used interchangeably. Synthetic cannabinoids were created for therapeutic and research purposes; however, despite legal efforts to limit their availability, synthetic cannabinoids have become an increasingly common drug of abuse, sold under various street names such as K2, Spice, and Black Mamba. Synthetic cannabinoids are associated with much more morbidity and mortality than the phytocannabinoids. Prescription preparations for medical usage include dronabinol, or pure THC, nabilone, a synthetic cannabinoid, and cannabidiol (CBD). Pharmaceutical use of cannabinoids is an ongoing field of research., (Copyright © 2022, StatPearls Publishing LLC.)

Ionizing radiation has been proven to be a risk factor for malignancy in the future. Evidence from studies conducted following the Chernobyl accident, nuclear tests, environmental radiation pollution, and accidental indoor contamination reveals consistently increased chromosome aberration and micronuclei frequency in those exposed to ionizing radiation. Ionizing radiation is of significant concern in the United States due to ubiquitous and often unnecessary imaging of patients with computerized tomography and x-rays. With the advent of multi-slice CTs, the indications for this imaging modality and its use is increasing. Although CT scans are often helpful for the clinician in making a diagnosis, they are not without risks. This risk of cancer later in life is most important for children. Ionizing radiation is cumulative. Once received, the effects remain in the body for life. As such, with increased levels of exposure to ionizing radiation to an individual, the greater the risk of malignancy later in life. Because children have more years of life remaining than adults, their cumulative risk of malignancy due to ionizing radiation is higher., (Copyright © 2022, StatPearls Publishing LLC.)

Irukandji syndrome is a painful, potentially lethal condition caused by certain jellyfish from the Cubozoa class (box jellyfish) species. Although the sting is usually mild, systemic symptoms resembling a catecholamine surge can result in approximately half an hour, including tachycardia, hypertension, severe pain, muscle cramping, and is often followed by hypotension, pulmonary edema, and potentially life-threatening cardiac complications.[1] The syndrome was named in 1952 by Hugo Flecker, after an Aboriginal tribe located near Cairns, North Queensland, Australia.[2] Irukandji syndrome is most notably caused by the jellyfish species Carukia barnesi , named after the scientist Jack Barnes, who discovered the species as the causative organism of the condition. Interestingly, he established the causative relationship after envenoming himself, his son, and a local lifeguard, which subsequently required treatment for the ensuing condition in a hospital.[3] As such, this particular species is commonly referred to as the “Irukandji jellyfish.”, (Copyright © 2022, StatPearls Publishing LLC.)

Ethylene glycol (C2H6O2) is a toxic alcohol that is found in various household and industrial agents. The term “toxic alcohols” is a collective term that includes methanol, ethylene glycol, and isopropyl alcohol. Ethylene glycol exposure can be extremely dangerous, with significant morbidity and mortality if left untreated. Ethylene glycol is a colorless, sweet-tasting liquid most commonly found in antifreeze, but occasionally used for other purposes, such as industrial solvents. Exposures are generally observed due to accidental or intentional ingestions, with its sweet taste lending to accidental toxic exposures, whereas intentional exposures may be motivated by a suicide attempt or desire for inebriation in the absence of ethanol. Ethylene glycol exposures can cause varying degrees of toxicity and management generally requires supportive care, close laboratory monitoring, and antidote therapy. The primary treatments are either ethanol or fomepizole and, occasionally, dialysis. [1], (Copyright © 2022, StatPearls Publishing LLC.)